Coronavirus. Three questions on ARS, under fire from critics for their management of

Decried since their birth, the all-powerful regional health agencies (ARS) focus criticism on their management of the coronavirus epidemic, but the government supports them against all odds because it is its action that is targeted through them .

What are ARS used for?

If they do not have the title, their directors are real health prefects at the scale of their regions.

Created by the Bachelot law, the ARS replaced in April 2010 the old regional hospitalization agencies (ARH), but also the health and social affairs departments (Drass, DDASS) and certain health insurance funds (Urcam, Cram ).

Their vast field of action includes hospitals, clinics, city care, medico-social (elderly and disabled), prevention and environment (quality of water and air).

ARS somehow play a role of conductor, while translating a desire for the State to take control of the management of health policies, sums up Henri Bergeron, director of research at the CNRS.

In particular, they have the power to open or close services (maternity, surgery, emergency) and to authorize certain equipment (scanner, MRI).

Above all, they hold the purse strings, distributing the operating credits of establishments, as well as aid of all kinds to local projects or caregivers installed in medical deserts.

This omnipotence has fueled a decade of frustration and resentment for the medical profession, supplanted by administration without any counterweight.

Grievances reinforced by the budgetary restrictions of the time: born in times of financial crisis, the ARS were from the outset accused of implementing an austerity policy.

What do we blame them for today?

The same as what we blame the state, of which they are the armed wing: bureaucratic heaviness, lack of responsiveness, fluctuating communication.

We probably fell behind in crisis management because we were dealing more with budgetary actors than with crisis logisticians, affirmed in early April the president of the Grand Est region, Jean Rottner.

At the end of March, at the height of the epidemic, a front-line observer was desperate to see the army evacuate patients from Mulhouse, while hospitals and clinics could accommodate them nearby.

ARS discussions are a disaster, he said, denouncing big ego wars, with agency directors who reign supreme over their territory, so much so that even the director of cabinet of the Minister of Health is not aware of the decisions taken regionally.

Revenge, the doctors are having fun, like François Honorat, president of the Union of liberal anesthetists: The ARS did not measure up. They prevent people from working, we will have to reform all that.

In the hot seat, agency directors now know they are on an ejection seat, since the dismissal of Christophe Lannelongue in the Grand Est.

In the midst of a health crisis, this senior official had defended the restructuring plan of the Nancy teaching hospital and its 600 layoffs, triggering the ire of local elected officials and opposition parties.

Who defends them?

The government, well aware that through the ARS, it is its action that is targeted.

Édouard Philippe thus welcomed their remarkable work to enable the resuscitation capacity to be ramped up, increased in a short time from 5,000 to more than 10,000 beds.

And Olivier Véran never misses an opportunity to recall their mobilization decisive in neutralizing the Haute-Savoie outbreak in early February, or in the 644 medical evacuations carried out by train, plane and helicopter.

Whatever the charge, the Minister of Health protects his administration. Carelessness in Ehpad? The ARS received very clear instructions for drawing up a daily inventory. Drug shortage? They establish priorities in the distribution of essential stocks. Christophe Lannelongue? A public servant who believed he was doing well.

Accountancy time has not yet come. But for researcher Henri Bergeron, a balance sheet of their action should indeed be carried out.

We thought a bit naively that from the moment we created a coordinating body, the cooperation between the actors would improve. The crisis revealed major coordination problems, at both national and local level, he observes.

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